Sama Nihad Sura Muthana

Sajad Fadel Shahad Habib

Taha Shreiff

Partial Denture
Support for the distal
extension denture base
Supervised by: Emad Abdullah
Support
resistance to vertical components of masticatory force in a
direction toward the basal seat.

All partial denture have two things in common:

1. They must be supported by oral structures.
2. They must be retained against reasonable dislodging forces.

Support can be classified according to Cradock:

1. Dental support. 2. Mucosal support.
3. Mixed, dental &mucosal /mucosal &dental support.
Designing support:
A. Tooth support: when abutment available at both ends of the denture base (bounded saddle). It
most commonly obtained by occlusal rests.

B. Mucosa support: (mucoperiosteum covering residual alveolar bone). It allows varying degree
of displacement.
The amount of displacement (tissue ward movement) will depend
on:
1. The amount of pressure applied.
2. The nature of the mucosa (thickness).
3. Area covered by the denture ( the wider area the less the displacement).
4. Fit of the denture.
5. Type of impression (anatomical, functional, or selective pressure)
C. Tooth-mucosa support: (bilateral free end saddle): Posterior tissue support &anterior
tooth support.

In class III PD three components are

necessary, support provided by rests, the
connectors (stabilizing components) &the
retainers.

An anatomical impression is the only needed to

record the anatomic form of the teeth &residual
ridge in tooth born RPD

The distal extension removable partial denture does not have the advantage of total tooth support
because one or more bases are extensions covering the residual ridge distal to the last abutment, but in
this situation , the support comes from both the teeth &the underlying ridge tissues rather than from
teeth alone
This is a composite support, &the prosthesis must be fabricated so that the resilient support provided by
the edentulous ridge is coordinated with the more stable support offered by the abutment teeth.

The distal extension removable partial denture must depend on the residual ridge for some support,
stability, and retention. Indirect retention, to prevent the denture from lifting away from the residual
ridge, should also be incorporated in the design.
In addition provision must be made for three other factors:
1. Best support must be obtained from the resilient tissues that cover
the edentulous ridges. This is accomplished by the impression
technique more than by the PD design. The area covered by the partial
denture base is a factor in such support.

2. The method of direct retention must take into account the inevitable
tissue ward movement of distal extension base (s) under the stress of
mastication and occlusion. Direct retainers must be designed so that the
occlusal loading will result in the direct transmission of this load to the
long axis of the abutment teeth.

3. The PD with one or more distal extension denture base, must be

designed so that movement of the unsupported and not retained end
away from the tissues will be prevented by indirect retainer.
The main problems which might occur in tooth-tissue support are:
1- Mucosa is resilient and displaceable and can lead to unstable prostheses.

2- Difficult to record mucosa at resting and at displaced condition simultaneously.

3- In distal ERPD under function compresses the mucosa and act as class I lever thus it cause
damaging to the abutment teeth, the solution is to record tissue in the functional form so the denture
not exert additional stress to the abutment teeth.
Factors influencing the support of a distal extension base:

1. Contour and quality of the residual ridge

2. Extent of residual ridge coverage by the denture base
3. Type and accuracy of the impression registration
4. Accuracy of the fit of the denture base
5. Design of the removable partial denture framework
6. Total occlusal load applied
1. Quality of the residual ridge for good support:

The ideal residual ridge to support a denture base would

consist of cortical bone that covers relatively dense cancellous
bone, with a broad rounded crest with high vertical slopes,
and is covered by firm, dense, fibrous connective tissue.
1. Quality of the residual ridge for good support:
The buccal shelf region (bounded by the external oblique line and the crest of the alveolar
ridge) in the lower ridge as a primary stress-bearing area, because it is covered by relatively
firm, dense, fibrous connective tissue supported by cortical bone. While the crest of the bone is
mostly cancellous bone not good for support. Unlike in the maxillary ridge the crest is primary
stress bearing area.
Slopes of the ridge can resist horizontal forces.
2. Extent of Residual Ridge Coverage by the Denture Base:
The broader the residual ridge coverage, the greater is the distribution of the load, which results in
fewer loads per unit area. A denture base should cover as much of the residual ridge as possible and
should be extended the maximum amount within the physiologic tolerance of the limiting border
structures or tissues lead to better distribution of load &better 8 withstanding of vertical &horizontal
forces. The longer the edentulous area covered by the denture base, the greater the potential lever
action on the abutment teeth.

withstanding of vertical &horizontal forces. The longer the edentulous area covered by the denture
base, the greater the potential lever action on the abutment teeth.

• Flat ridge will provide good support, poor stability.

• Sharp spiny ridge will provide poor support, poor to fair stability.

• Displaceable tissue on ridge will provide poor support & poor stability.
2. Extent of Residual Ridge Coverage by the Denture Base:

The distal end RPD derives its support from the residual ridge with its fibrous
connective tissue covering. The length &contour of residual ridge significantly
influence the amount of available support &stability.

3. Type and Accuracy of the Impression Registration:

A. The anatomic form: The anatomic form is the surface contour of the ridge
when it is not supporting an occlusal load. The anatomic form &the relationship
of the remaining teeth in the dental arches, as well as the surrounding soft tissue,
must be recorded accurately so that the denture will not exert pressure on those
structures.

B. The functional form: is the surface contour of the ridge when it is supporting a
functional load.
3. Type and Accuracy of the Impression Registration:

The support form of the soft tissues underlying the distal end base of the PD
should be recorded so that firm areas as primary stress-bearing areas and readily
displaceable tissues are not overloaded, only in this way can maximum support of
the PD base be obtained.

McLean and others recognized the need to record the tissues that support a distal
extension removable partial denture base in their functional form, or supporting
state, and then relate them to the remainder of the arch by means of a secondary
impression. This was called a functional impression because it recorded the ridge
relation under simulated function.
Many of the requirements and advantages are associated with the distributed
stress denture apply equally well to the functionally or physiologically based
denture. Some of these requirements are
(1) positive occlusal rests
(2)an all-rigid, nonflexible framework
(3) indirect retainers to add stability
(4) well-adapted, broad coverage bases.
4. Accuracy of the Fit of the Denture Base:
Support of the distal extension base is enhanced by intimacy of
contact of the tissue surface of the base and the tissues that cover the
residual ridge. The tissue surface of the denture base must optimally
represent a true negative of the basal seat regions of the master cast.

In addition, the denture base must be related to the removable partial

denture frame work in the same manner as the basal seat tissues were
related to the abutment teeth when the impression was made. Every
precaution must be taken to ensure this relationship when the altered
cast technique of making a master cast is used.
5. Design of the Removable Partial Denture Framework:
Some rotation movement of a distal extension base at the distal abutment is inevitable under
functional loading. The greatest movement takes place at the most posterior extent of the
denture base. The retromolar pad region of the mandibular residual ridge and the tuberosity
region of the maxillary residual ridge therefore are subjected to the greatest movement of the
denture base.
• Use of more anterior or mesial rest is suggested as it allow
vertical ridge loading, permit greater ridge for support,
transfer stress to anterior abutment.
• Incorporation of indirect retainer.
• Incorporation of RPI system in free end saddle which make
stress release.

6. Total Occlusal Load Applied:

Patients with distal extension removable partial dentures generally orient the food bolus
over natural teeth rather than prosthetic teeth, because of :
1. The more stable nature of the natural dentition.
2. The proprioceptive feedback they provide for chewing.
3. The possible nocioceptive feedback from the supporting mucosa
This has an effect on the direction and magnitude of the occlusal
load to the removable partial denture, and thus on the load
transferred to the abutments.

The support from the residual ridge should be optimized and

shared appropriately with the remaining natural dentition.

The number of artificial teeth, the width of their occlusal surfaces,

and their occlusal efficiency influence the total occlusal load
applied to the removable partial denture.

The reduction of the size of the occlusal table reduces the vertical
and horizontal forces that act on the removable partial dentures
and lessens the stress on the abutment teeth and supporting
tissues.
Anatomical Form Impression
The anatomic form impression is a one-stage impression method
using an elastic impression material that will produce a cast that
does not represent a functional relationship between the various
supporting structures of the partially edentulous mouth. It will
represent only the hard and soft tissues at rest.

With the removable partial denture in position in dental arch, the

occlusal rest will fit the rest seat of the abutment teeth, while the
denture base will fit the surface of the mucosa at rest.
Anatomical Form Impression
When a masticatory load is applied to the extension base(s) with a
food bolus, the rest(s) will act as a definite stop, which will limit
the part of the base near the abutment tooth from transmitting the
load to the underlying anatomic structures.

The distal end of the base(s), however, that is able to move more
freely, will transmit more of the masticatory load to the
underlying extension base tissues and will transmit more torque to
the abutment teeth through the rigid removable partial denture
framework.
Anatomical Form Impression
A removable partial denture fabricated from a one-stage
impression, which records only the anatomic form of basal seat
tissues, places more of the masticatory load on the abutment teeth
and that part of the bone that underlies the distal end of the
extension base.
Methods for obtaining functional support from the distal
extension base:
The objective of any functional impression technique is to provide
maximum support for the removable partial denture bases.

- This allows for the maintenance of occlusal contact between

natural and artificial teeth.
- Minimal movement of the base, which would create leverage on
the abutment teeth.
Methods for obtaining functional support from the distal
extension base:
- Some tissue-ward movement of the distal extension base is
unavoidable and dependent on six factors listed previously, it can be
minimized by best possible support for denture base.

- No single impression material can record both the anatomic form of

the teeth and tissues in the dental arch and, at the same time, the
functional form of the residual ridge. Therefore, some secondary or
corrected impression method must be used.

- Methods for obtaining functional support for either should satisfy

the two requirements for providing adequate support to the distal
extension removable partial denture base. these are:
(1) that it records and relates the supporting soft tissue under some
loading, and
(2) that it distributes the load over as large an area as possible.

Selective tissue placement impression method :

Soft tissues that cover basal seat areas may be placed, displaced, or
recorded in their resting or anatomic form. Placed and displaced tissues
differ in the degree of alteration from their resting form and in their
physiologic reaction to the amount of displacement.

For example, the palatal tissues in the vicinity of the vibrating line can
be slightly displaced to develop a posterior palatal seal for the
maxillary complete denture and will remain in a healthy state for
extended periods. On the other hand, these tissues develop an
immediate inflammatory response when they have been overly
displaced in developing the posterior palatal seal.
Selective tissue placement impression method :
Oral tissues that have been overly displaced or distorted attempt to
regain their anatomic form. When they are not permitted to do this by
the denture bases, the tissues become inflamed and their physiologic
functions become impaired, accompanied by bone resorption.

Tissues that are minimally displaced (placed) by impression

procedures for definitive border control respond favorably to the
additional pressures placed on them by the resultant denture bases if
these pressures are intermittent rather than continuous.

The selective tissue placement impression method is based on these

clinical observations:
1. The histologic nature of tissues that cover the residual alveolar bone.
Selective tissue placement impression method :

2. The nature of the residual ridge bone.

3. and its positional relationship to the direction of stresses that will be
placed on it.

It is further believed that by use of specially designed individual trays for

impressions, denture bases can be developed that will use those portions
of the residual ridge that can withstand additional stress and at the same
time relieve the tissues of the residual ridge that cannot withstand
functional loading and remain healthy.
References
• K Giffin Providing intraosseous anesthesia with minimal invasion
J Am Dent Assoc (1994)

• A Krol et al.
Removable partial denture design (1990)

• S Lewis
Implant-retained overdentures Compend Contin Educ Dent (1993)

• P Staubi
Attachment reference manual (1984)